Persistent providers sway parents to accept HPV vaccination

Key clinical point: A majority of unvaccinated adolescents received the HPV vaccine when clinicians engaged with hesitant parents.

Major finding: At 18 office visits when parents hesitated but doctors persisted, 17 adolescents received the HPV vaccine

Study details: The data come from audio recordings of 43 visits to six pediatric clinics in Dallas at which parents were unsure about HPV vaccination for their teens.

Disclosures: The study was funded by the National Institutes of Health. Additional support was provided by the Simmons Comprehensive Cancer Center, University of Texas Southwestern Center for Translational Medicine, through the NIH and National Center for Advancing Translational Sciences, and University of Texas Southwestern Center of Patient-Centered Outcomes Research. Dr. Shay and her associates had no financial conflicts.

When health care providers address parental concerns about human papillomavirus (HPV) vaccination, adolescents are more likely to be vaccinated at that same visit, according to data from 43 pediatrician clinic visits at six clinics in Texas.

Vaccine hesitancy is on the rise among parents in the United States, wrote Laura A. Shay, PhD, of the University of Texas School of Public Health, San Antonio, and her colleagues. “Although vaccine hesitancy is subject to influence, to our knowledge, no authors of previous studies have analyzed actual provider discussions with undecided parents to explore how parents express hesitancy about the HPV vaccine and how providers respond.”

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In a study published in Pediatrics, the researchers conducted audio recordings of 43 pediatric visits with adolescents accompanied by parents who were unsure about HPV vaccination. Parents gave consent to the recording and received $25 gift cards to participate. A researcher turned on the audio, then left the parent, teen, and health care provider alone and recorded the complete visit. All 43 parents were women; 72% were Hispanic and 28% African American, and 27 visits were conducted in Spanish and 9 involved an interpreter.

Overall, 37 parents expressed hesitancy one or more times in different ways, including assertive responses (such as “No, not right now” or “We need to think about that”) at 27 visits, questions (such as “Is it safe?”) at 16 visits, and concerns (such as “I’m just nervous about it”) at 12 visits.

In responding to these parents, pediatricians used only persistence to promote vaccination in 18 cases, a combination of acquiescence and persistence in 13 cases, and only acquiescence in 6 cases. The teens were vaccinated the same day in 17 of the 18 cases of persistence, compared with only 2 of 13 cases of combined acquiescence and persistence, and none of the 6 cases in which health care providers acquiesced to parents’ concerns without further discussion.

The findings were limited by several factors, including a relatively homogeneous population of low socioeconomic families, too small a sample to determine significance, and possible influence of the audio recorder on behavior, Dr. Shay and her researchers noted. However, the results provide a framework for studies of parental hesitancy in larger and more diverse groups. “Parental hesitancy is an opportunity to practice patient-centered communication. Without understanding the source of parental hesitancy, a provider’s response may not be suitably tailored to counter hesitation”

“With our exploratory examination of the relationship between parent-provider communication about HPV vaccine hesitancy and vaccination behavior, we suggest that persistently engaging parents who express hesitancy can lead to same-day vaccinations and that these conversations are short (approximately 2-3 minutes),” they added.